Beruflich Dokumente
Kultur Dokumente
Clinical Radiology
journal homepage: www.clinicalradiologyonline.net
Technical Report
Article history:
Received 4 December 2013
Accepted 19 November 2014
http://dx.doi.org/10.1016/j.crad.2014.11.013
0009-9260/Ó 2015 The Royal College of Radiologists. Published by Elsevier Ltd. All rights reserved.
236 J.R. Panchmatia et al. / Clinical Radiology 70 (2015) 235e242
Scoliosis is not a two-dimensional condition; rather, it is distance between the C7 vertebral body plumb line and
a three-dimensional condition associated not only with a the central sacral vertical line. Normal global coronal
lateral curvature but also with a degree of vertebral rota- balance is when the distance between the C7 vertebral
tion. The greater the degree of displacement of the convex body plumb line and the central sacral vertical line is less
pedicle in relation to the centre of vertebral body, the than 1 cm.22 Regional imbalance, on the other hand,
greater the degree of rotation.20 Several methods have tends to focus on shoulder asymmetry. This is in part
been described for radiographic assessment of rotation, because shoulder asymmetry has been shown to be a
including the Nash and Moe, Pedriolle, and Vidal source of psychological distress in patients with scoliosis.
methods.21 Assessment of vertebral rotation is performed Moreover, correction of shoulder imbalance strongly in-
clinically or more accurately on cross-sectional imaging fluences patient satisfaction with surgical outcomes.
(CT/ MRI). Shoulder asymmetry can be quantified by measuring the
clavicle angle. This is the angle subtended by a line con-
7. Assess coronal balance (Fig 7). necting the distal aspect of both clavicles and the
horizontal.23
Patient symptoms are in part a reflection of truncal
imbalance. Truncal imbalance has two components: cor- 8. Assess skeletal maturity (Fig 8).
onal and sagittal. Global and regional coronal imbalance
can be assessed using a posteroanterior radiograph. Skeletal maturity can be estimated by assessing the
Global coronal imbalance is quantified by measuring the degree of ossification of the iliac crest apophysis using the
J.R. Panchmatia et al. / Clinical Radiology 70 (2015) 235e242 239
Lateral radiograph
Figure 9 Lateral bending views confirming the presence of structural thoracic and thoracolumbar curves. These images have been flipped in the
horizontal plane so that they mimic the patient lying prone on the operating table. This is the norm at many spinal units. This ensures that
pre- operative imaging can easily be correlated with intra- operative surgical and radiological findings.
J.R. Panchmatia et al. / Clinical Radiology 70 (2015) 235e242 241
References 14. Lonstein JE, Carlson JM. The prediction of curve progression in untreated
idiopathic scoliosis during growth. J Bone Joint Surg (Am)
1. Marketos SG, Skiadas P. Hippocrates. The father of spine surgery. Spine 1984;66:1061e71.
1996;24:1381e7. 15. Suk AI, Kim JH, Kim SS, et al. Pedicle screw instrumentation in adoles-
2. Weiss H, Negrini S, Rigo M, et al. Indications for the conservative cent idiopathic scoliosis. Eur Spine J 2012;21:13e22.
management of scoliosis (guidelines). Scoliosis 2006;1:5. 16. Ron E. Ionizing radiation and cancer risk: evidence from epidemiology.
3. Kleinberg S. The operative treatment of scoliosis. Arch Surg Pediatr Radiol 2002;32:232e7.
1922;5:631e45. 17. Mody MG, Nourbakhsh A, Stahl DL, et al. The prevalence of wrong level
4. Anderson DG, Vaccaro AR. Decision making in spinal care. New York: surgery among spine surgeons. Spine 2008;33:194e8.
Thieme Medical Publishers; 2006. 18. Paik NC, Lim CS, Jang HS. Numeric and morphological verification of
5. James JI. Idiopathic scoliosis; the prognosis, diagnosis, and operative lumbosacral segments in 8230 consecutive patients. Spine
indications related to curve patterns and the age at onset. J Bone Joint 2013;38:E573e8.
Surg (Br) 1954;36:36e49. 19. Lenke LG, Betz RR, Harms J, et al. Adolescent idiopathic scoliosis: a new
6. Miller MD. Pediatric orthopaedics. In: Review of orthopaedics. 5th ed. classification to determine extent of spinal arthrodesis. J Bone Joint Surg
Philadelphia: Saunders; 2008. p. 215. (Am) 2001;83:1169e81.
7. Asher MA, Burton DC. Adolescent idiopathic scoliosis: natural history 20. Nash Jr CL, Moe JH. A study of vertebral rotation. JBJS (Am)
and long term treatment effects. Scoliosis 2006;31:1e10. 1969;51:223e9.
8. Lonstein JE. Scoliosis: surgical versus nonsurgical treatment. Clin Orthop 21. Pedriolle R, Vidal J. Morphology of scoliosis: three-dimensional evolu-
Relat Res 2006;443:248e59. tion. Orthopedics 1987;10:909e15.
9. Cassar-Pullicino VN, Eisenstein SM. Imaging in scoliosis: what, why and 22. Qiu X, Ma W, Li W, et al. Discrepancy between radiographic shoulder
how? Clin Radiol 2002;57:543e62. balance and cosmetic shoulder balance in adolescent idiopathic scoli-
10. Goldberg MS, Poitras B, Mayo NW, et al. Observer variation in assessing osis patients with double thoracic curve. Eur Spine J 2009;18:45e51.
spinal curvature and skeletal development in adolescent idiopathic 23. Malfair D, Flemming AK, Dvorak MF, et al. Radiographic evaluation of
scoliosis. Spine 1988;13:1371e7. scoliosis: review. AJR Am J Roentgenol 2010;194:S8e22.
11. Morrissy RT, Goldsmith GS, Hall EC, et al. Measurement of the Cobb 24. Morvan G, Mathieu P, Vuillemin V, et al. Standardized way for imaging
angle on radiographs of patients who have scoliosis. Evaluation of of the sagittal spinal balance. Eur Spine J 2011;20:602e8.
intrinsic error. J Bone Joint Surg (Am) 1990;72:320e7. 25. Harding IJ. Understanding sagittal balance with a clinical perspective.
12. Beauchamp M, Labelle H, Grimard G, et al. Diurnal variation of Cobb angle Eur J Phys Rehbil Med 2009;45:571e82.
measurement in adolescent idiopathic scoliosis. Spine 1993;18:1581e3. 26. Nnadi C, Roussouly P. Sagittal plane deformity: an overview of inter-
13. Aubin CE, Labelle H, Ciolofan OC. Variability of spinal intrumentaion pretation and management. Eur Spine J 2010;19:1824e36.
configurations in adolescent idiopathic scoliosis. Eur Spine J 27. ICRP. 1990 Recommendations of the International Commission on
2006;16:57e64. Radiological Protection. ICRP Publication 60. Ann ICRP 1991;21(1e3).